NPIMap

Organization Active NPI

340 Desoto Avenue Ext Operations, LLC

Doing business as Greenbough Health and Rehabilitation Center

  • Skilled Nursing Facility
  • Clarksdale, MS
National Provider Identifier
1932856531
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
340 DESOTO AVENUE EXT OPERATIONS, LLC
Doing business as
Greenbough Health and Rehabilitation Center
Practice address
340 Desoto Avenue Ext
Clarksdale, MS 38614-2814
Phone
(253) 278-2258
Fax
(662) 627-5654
NPI assigned
Mar 4, 2022
Last updated
Sep 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ashley Winkle
Title
LLC Manager
Phone
(770) 698-9040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

340 Desoto Avenue Ext
Clarksdale, MS 38614-2814

Mailing address

340 Desoto Avenue Ext
Clarksdale, MS 38614-2814
Phone (662) 627-3486

Other identifiers 1

IdentifierTypeStateIssuer
000230119MedicaidMS

Other names 1

  • Greenbough Health and Rehabilitation Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other Consulate Healthcare

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220530000105 MS Part A Provider - Skilled Nursing Facility 5597143867 Practice locations: Clarksdale, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932856531. Details of each certification follow.

Skilled nursing facility certification: CCN 255294

Legal name
340 DESOTO AVENUE EXT OPERATIONS, LLC
Doing business as
GREENBOUGH HEALTH AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 2002
Last certification
Jun 5, 2024
Beds
60
Ownership / control type
Corporation
Multi-facility organization
Avardis
Organization structure
LLCProprietary
Incorporated
Dec 21, 2021 in FL
Enrollment address
340 Desoto Avenue Ext
Clarksdale, MS 38614-2814
Nursing home name
GREENBOUGH HEALTH AND REHABILITATION CENTER
Affiliated entity
CONSULATE HEALTH CARE/INDEPENDENCE LIVING CENTERS/NSPIRE HEALTHCARE/RAYDIANT HEALTH CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Greenbough Health and Rehabilitation CenterCCN 255294 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Dec 1, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6054.6 residents per day on average
Chain
Consulate Health Care/Independence Living Centers/Nspire Healthcare/Raydiant Health Care11 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
LV Investment LLC Organization, Maitland, FL LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 100%
NSPR Operations II, LLC Organization, Tamarac, FL LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 100%
Ashley Winkle Individual Operational/Managerial Control Dec 10, 2024
Adp of the SNF Dec 1, 2023
Fglfc Holdco, LLC Organization, Tamarac, FL LLC, For-profit, Owned by another organization or individual Direct Ownership Interest Apr 1, 2022 100%
FC Investors Xxi LLC Organization, Maitland, FL LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 100%
SNF MGR LLC Organization, Atlanta, GA LLC, Management services company, For-profit, Chain home office Operational/Managerial Control Jun 1, 2025
Adp of the SNF Apr 7, 2026
Kathy Conrad Individual Operational/Managerial Control Jan 12, 2026
Adp of the SNF Jan 12, 2026
John Thomas Individual Operational/Managerial Control Apr 1, 2022
Managing Control - Governing Body Apr 1, 2022
Adp of the SNF Apr 1, 2022
NSPR Care Centers, LLC Organization, Tamarac, FL LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 100%
Tiffany Hoback Individual Managing Control - Governing Body Jun 1, 2025
Adp of the SNF Jun 1, 2025
NSPR Operations I, LLC Organization, Tamarac, FL LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 100%
Irene S Buckner Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Lavie Holdco LLC Organization, Atlanta, GA LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 41

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 41

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1932856531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 DESOTO AVENUE EXT",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386142814",
            "telephone_number": "662-627-3486",
            "fax_number": "662-627-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 DESOTO AVENUE EXT",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386142814",
            "telephone_number": "253-278-2258",
            "fax_number": "662-627-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "340 DESOTO AVENUE EXT OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-04",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A",
        "authorized_official_last_name": "WINKLE",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "LLC MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000230119",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "affiliationName": "Consulate Healthcare",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Greenbough Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greenbough Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksdale, MS

Sources for this page

Verify at the official NPI Registry.